title: For whom does it work? moderators of outcome on the effect of a transdiagnostic internet-based maintenance treatment after inpatient psychotherapy: randomized controlled trial.
abstract: BACKGROUND
  Recent studies provide evidence for the effectiveness of Internet-based maintenance treatments for mental disorders. However, it is still unclear which participants might or might not profit from this particular kind of treatment delivery.
  
  
  OBJECTIVE
  The study aimed to identify moderators of treatment outcome in a transdiagnostic Internet-based maintenance treatment (TIMT) offered to patients after inpatient psychotherapy for mental disorders in routine care.
  
  
  METHODS
  Using data from a randomized controlled trial (N=400) designed to test the effectiveness of TIMT, we performed secondary analyses to identify factors moderating the effects of TIMT (intervention) when compared with those of a treatment-as-usual control condition. TIMT involved an online self-management module, asynchronous patient-therapist communication, a peer support group, and online-based progress monitoring. Participants in the control condition had unstructured access to outpatient psychotherapy, standardized outpatient face-to-face continuation treatment, and psychotropic management. Self-reports of psychopathological symptoms and potential moderators were assessed at the start of inpatient treatment (T1), at discharge from inpatient treatment/start of TIMT (T2), and at 3-month (T3) and 12-month follow-up (T4).
  
  
  RESULTS
  Education level, positive outcome expectations, and diagnoses significantly moderated intervention versus control differences regarding changes in outcomes between T2 and T3. Only education level moderated change differences between T2 and T4. The effectiveness of the intervention (vs control) was more pronounced among participants with a low (vs high) education level (T2-T3: B=-0.32, SE 0.16, P=.049; T2-T4: B=-0.42, SE 0.21, P=.049), participants with high (vs low) positive outcome expectations (T2-T3: B=-0.12, SE 0.05, P=.02) and participants with anxiety disorder (vs mood disorder) (T2-T3: B=-0.43, SE 0.21, P=.04). Simple slope analyses revealed that despite some subgroups benefiting less from the intervention than others, all subgroups still benefited significantly.
  
  
  CONCLUSIONS
  This transdiagnostic Internet-based maintenance treatment might be suitable for a wide range of participants differing in various clinical, motivational, and demographic characteristics. The treatment is especially effective for participants with low education levels. These findings may generalize to other Internet-based maintenance treatments.
authors.affiliation: Innovation Incubator, Division Health-Training.Online, Leuphana University Lueneburg, Lüneburg, Germany. Ebert@leuphana.de.
authors.forename: David Daniel
authors.initials: DD
authors.lastname: Ebert
authors.forename: Mario
authors.initials: M
authors.lastname: Gollwitzer
authors.forename: Heleen
authors.initials: H
authors.lastname: Riper
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
authors.forename: Harald
authors.initials: H
authors.lastname: Baumeister
authors.forename: Matthias
authors.initials: M
authors.lastname: Berking
mesh_terms: D000328:Adult; D000359:Aftercare; D005260:Female; D006801:Humans; D007297:Inpatients; D020407:Internet; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D011613:Psychotherapy; D016896:Treatment Outcome
keywords: Internet-based intervention; continuation treatment; guided self-help; maintenance treatment; mental disorders/inpatient psychotherapy; moderators; predictors; randomized controlled trial; relapse prevention; transdiagnostic treatment